Death Certificate - Stone, James W_10/10/2013 l,L1 rtSSLb
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INDIANA STATE DEPARTMENT OF HEALTH
a/-"atti, CERTIFICATE OF DEATH
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Local No.Ji7/./.0 State NO..0 CZ Sa
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James W Stone Male
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86 M.C. OSO man a.,.. Nov 23, 1921 Fort Branch, Indiana
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Deaconess Primary Care 802 E. Oak Street
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Ruth Harmon Harmon Mail Carrier Q Ot'et:tts..7 wC CeX"
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Indiana Gibson Fort Branch
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501 N Hull St 47648
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V Feas'a Name(Feet Mate.Last) n Mars Name(Fes.Maaae.Lao) Ma. Moan Maiden Last Name •
Luther Stone Hazel ( Warren
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Ruth Stone Wife 501 N Hull St Fort Branch, IN 47648
25. Place Of Disposition
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/ / Cause Of Death(See Inats ucGan And Examples)
2S P.Y. Eta The Fm..,0'Forms-Amases. , .Or Comi8ealims—That Dirldly Caused The Deals, Do Nd Enter Terminal Approximate
Sohn As Carats:Arco,Respiratory Anent Or Verinoj f Fibri]alnn COMM`• -. , - Do Wolf»Men. Enter Orty One• On lann al' Cassel
A Liner. Ad:Aa0`„oni Lew If Necessary. A - e \ , \� To Death
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(�aa� 0 CC:}rg Physician 0 Cava 0 Heal hex
d3 Non,A24,cs Ark Lo Gas Q Person Cetfin:,Ca .l'21IM1 era. License Meta 45 Oaa Dmvea
Larry Lutz, Dr. 802 E. 0 St Fort Branch, IN 47648-
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MIS IS AN EXACT lsin r 0111 rO Si Cn OFUAIU LOP HAS Itllaa tLL ANT IS ON RECORD IN RAISED SEAL OF THE HEALTH rra/WE@ALTM
UC nT C r n ' G O Uh GE OCnCO n rU COPY unit ]dµFU Y.1111 T11F OFFICIAL fNSTp$CAL OF HEALTH OEPA/WENT
STAMPED wur NIL 111 lllI MOCER SIGNATURE �(}(� -
OLC �JUL 2008 ::.E.bl Illnl.l I I OFFICER OF GIBSONCOLN'Y else • U-"111 RC -
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